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Gas embolism is commonly known as a risk factor for all laparoscopic procedures. We report a case of severe cerebral infarction presumably caused by paradoxical CO<jats:sub>2<\/jats:sub>\u00a0embolism in laparoscopic partial hepatectomy with an insufflation management system.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A male in his 60\u00a0s was diagnosed with recurrence of liver metastasis in the right hepatic lobe after laparoscopic lower anterior resection for rectal cancer. We performed laparoscopic partial hepatectomy with an AirSeal\u00ae under 10\u00a0mmHg of intra-abdominal pressure. During the surgery, the patient\u2019s end-tidal CO<jats:sub>2<\/jats:sub> and percutaneous oxygen saturation dropped from approximately 40\u201320\u00a0mmHg and 100\u201390%, respectively, while the heart rate increased from 60 to 120 beats\/min; his blood pressure remained stable. Postoperatively, the patient developed right hemiplegia and aphasia. Brain magnetic resonance imaging showed cerebral infarction in the broad area of the left cerebral cortex. Thereafter, transesophageal echocardiography revealed a patent foramen ovale, suggesting cerebral infarction due to paradoxical gas embolism.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>A patent foramen ovale is found in approximately 15\u201320% of healthy individuals. While gas embolism is a rare complication of laparoscopic surgery, cerebral infarction must be considered a possible complication even if the intra-abdominal pressure is constant under 10\u00a0mmHg with an insufflation management system.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40792-023-01611-0","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T05:25:49Z","timestamp":1677648349000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cerebral infarction by paradoxical gas embolism detected after laparoscopic partial hepatectomy with an insufflation management system: a case report"],"prefix":"10.1186","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4865-2222","authenticated-orcid":false,"given":"Kenji","family":"Shimizu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Usuda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuta","family":"Kakizaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Narita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"On","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kengo","family":"Fukuoka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,3,1]]},"reference":[{"key":"1611_CR1","doi-asserted-by":"publisher","first-page":"687","DOI":"10.12659\/AJCR.903777","volume":"18","author":"T Kawahara","year":"2017","unstructured":"Kawahara T, Hagiwara M, Takahashi H, Tanaka M, Imai K, Sawada J, et al. 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